Correlation between blood glucose variability and TOAST type of patients with acute ischemic stroke

Abstract

Objective To study the correlation between blood glucose variability and TOAST type of patients with acute ischemic stroke and provide new evidence which can improve the prognosis of ischemic stroke. Methods One hundred and forty-three hospitalized patients with acute ischemic stroke from August 2013 to August 2014 were included. All patients were estimated about the general state of health and performed laboratory examinations and other auxiliary examinations. Then the TOAST type of all cases was classified. The 24-hour blood glucose monitoring was done to the patients to calculate the blood glucose variability. One hundred and forty-three cases were divided into blood glucose variability group (standard deviation of glucose(GluSD)≥1.4 mmol/L, 85 cases) and control group (GluSD<1.4 mmol/L, 58 cases) according to glucose variability. We estimated the neurologic impairment of the patients with the US National Institutes of Health Stroke Scale (NIHSS) and the activities of daily living with Barthel index. The relation between blood glucose variability and the prognosis of ischemic stroke was analysed with multivariate analysis. Results Differences were significant in age, history of diabetes and NIHSS score between blood glucose variability group and control group. The degree of neurologic impairment of large artery atherosclerosis (LAA) group (moderate and severe neurologic impairment: 43/53(81.0%)) and cardio-aortic embolism (CE) group (moderate and severe neurologic impairment: 15/17) was more serious than that in small artery occlusion (SAO) group (moderate and severe neurologic impairment: 6/71(8.5%)), especially in CE group. The differences were significant (χ2=7.043, P<0.05). Blood glucose variability in patients with LAA was more obviously than that in other patients. NIHSS score and activities of daily living of the patients estimated on admission and after 2 weeks were not different in the blood glucose variability group, but the difference was significant in control group. The poor prognosis in blood glucose variability group was 2.821 times that in control group (95% CI 1.880-4.233). Conclusions The people sufferd ischemic stroke with old age, diabetes or severe case are more vulnerable to abnormal blood glucose variability. Abnormal blood glucose variability is an independent risk factor for acute ischemic stroke and induces difficulty to recovery and poor prognosis. Key words: Stroke; Brain ischemia; Blood glucose; Risk factors; Age factors; Prognosis